HX64119114 
RC201  .Ir9  Conquering  an  old  en 


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CONQUERING 

AN   OLD   ENEMY 


BY 

WILL    IRWIN 


THE    AMERICAN  SOCIAL  HYGIENE  ASSOCIATION 

Incorporated 
370    SEVENTH    AVENUE,   NEW  YORK 


Copyright,  1 910,  by 

The  American  Social  Hygiene  Association,  Inc. 

Publication  No.  2.50 


CONQUERING  AN   OLD   ENEMY 

Bv  Will  Irwin 


T^WO  young  men,  escorting  two  very  nice  young  girls,  once 
went  boating  on  a  Western  river.  Suddenly  they  heard  muffled 
shouts  from  the  rapids  below  them.  They  looked  and  saw  that 
a  man,  swimming,  had  been  caught  in  the  swift  current,  was  going 
under.  The  young  men  rowed  toward  him.  And  then,  one  of  the  girls 
began  to  scream. 

"Heavens!"  she  cried,  "we  can't  take  him  aboard.  He  isn't  dressed! 
He's — he's  naked!"  The  other  girl  joined  in  the  protest.  Their  escorts, 
ignoring  all  this,  continued  to  row.  The  girls  went  hysterical.  They 
clutched  at  the  arms  of  the  rowers.  Before  that  struggle  finished,  it 
was  too  late.  The  swimmer  had  gone  under  for  the  last  time.  All  this 
happened,  exactly  as  I  tell  it,  in  the  Far  West  when  I  was  a  boy. 

These  were  foolish  girls,  lacking  in  all  sense  of  proportion.  And  still, 
neither  you  nor  I  can  afford  to  cast  against  them  the  first  stone;  for 
this  little  story  is  an  allegory  of  the  human  race.  In  these  United 
States  and  in  this  year  of  peace  1920,  more  lives  than  the  whole  em- 
pire of  Great  Britain  lost  during  any  year  of  the  Great  War  will  be 
flicked  out  by  two  diseases  which  are  curable  and  preventable  dis- 
eases. Nor  will  the  year  1920  stand  alone.  In  the  four  and  a  half  years 
of  intensive  warfare  between  1914  and  1918,  the  fifteen  civilized 
nations  which  fought  at  Armageddon  gave  to  these  twin  scourges  a 
heavier  toll  than  they  did  to  bullets,  shells,  gas,  air-bombs,  all  the 
ghastly,  wholesale  killers  of  modern  battle.  Yet  these  two  diseases 
present  no  mystery  to  the  modern  physician.  They  may  be  cured; 
and  their  infection  can  be  checked  at  its  source.  Why,  then,  have  we 
not  acted,  we  who  thought  we  were  civilized?  Because  we  as  a  world 
have  assumed  the  attitude  of  the  silly  girls  in  the  boat.  We  have  been 
too  nice,  too  rotten,  nasty  nice,  to  organize  and  come  out  in  open 
fight  against  syphilis  and  gonorrhea. 

Even  medical  science  has  seemed  until  lately  to  struggle  against 
this  same  handicap  of  modesty.  We  have  long  understood  the  dangers 

CO 


and  horrors  of  tuberculosis  and  cancer;  but  not  until  the  last  decade 
or  so  has  any  one  known  exactly  how  terrible  are  the  "secret  diseases," 
the  "social  diseases,"  the  "hidden  scourges."  At  last,  we  have  seen 
the  face  of  the  enemy.  The  facts  which  I  am  about  to  quote  are  not 
the  conjectures,  guesses,  and  exaggerations  of  partisans  and  alarm- 
ists. They  are  a  brief  synopsis  of  cold  statistics  gathered  by  calm  men 
of  science,  proved  and  approved  by  our  government. 

Of  the  two  diseases,  syphilis  is  by  far  the  greater  killer — at  least 
directly.  In  its  fatal  tertiary  stage,  it  runs  into  several  well-recognized 
complaints  which  must  be  reckoned  in  the  indictment.  Every  case  of 
locomotor  ataxia,  for  example,  is  in  origin  syphilitic, — there  is  no 
other  cause  for  this  grotesque  and  terrible  affliction.  The  same  thing 
is  true  of  paresis.  Again,  a  definite  proportion  of  other  fatal  diseases, 
such  as  certain  varieties  of  organic  brain,  heart,  and  kidney  diseases, 
have  for  origin  syphilis.  It  is  estimated  by  authorities  that,  together, 
they  kill  annually  in  these  United  States  more  than  300,000  people. 
France,  we  used  to  say,  was  "bled  white"  in  the  war.  She  lost  about 
1,350,000  lives  by  the  fatalities  of  battle.  During  the  four  years  and 
four  months  of  Armageddon,  our  tribute  to  syphilis  was  about  the 
same  as  hers  to  the  Kaiser.  It  causes,  year  in  and  year  out,  two 
American  deaths  out  of  thirteen,  leading  by  a  wide  margin  tubercu- 
losis, which  is  next  on  the  list.  That  dreaded  "white  plague";  heart 
disease,  the  terror  of  declining  years;  pneumonia,  the  savage  slayer  of 
maturity,  the  gentle  reliever  of  age;  cancer,  the  dark  mystery  of 
science — all  give  place  to  syphilis.  When  we  consider  that  America 
is  on  the  whole  less  generally  infected  than  Europe,  we  must  realize 
that  it  is  the  chief  enemy  of  the  white  race.  Again  I  say:  I  am  reporting 
not  the  fancies  of  alarmists,  but  the  approved  facts  of  cold  science. 

None  of  this  generation  is  likely  to  forget  the  influenza  of  1918. 
This  was  a  swift,  raging  epidemic,  as  syphilis  is  a  slow,  persistent 
one.  In  that  year,  when  the  new  plague  divided  interest  with  the 
war,  syphilis  was  quietly  taking  nearly  if  not  quite  as  many  lives  as 
influenza.  The  influenza  epidemic  ran  its  course  in  a  year  and  dis- 
appeared; not,  probably,  to  return  in  such  a  form  for  many  years. 
Syphilis  goes  on  the  same,  year  after  year.  Its  percentage  of  deaths 
for  1918  was  virtually  the  same  as  for  1917,  1916,  1915 — for  every 
period  since  medical  statistics  enabled  us  to  see  what  it  is  doing.  And 
unless  we  act,  its  death-roll  will  never  diminish. 

[»] 


To  finish  the  indictment  against  syphilis,  no  disease  worth  con<= 
sidering  is  inherited.  The  theory  of  hereditary  cancer  was  exploded 
long  ago.  Neither  tuberculosis  nor,  strictly  speaking,  the  tuberculous 
tendency  passes  on  from  generation  to  generation.  But  syphilis— stating 
the  matter  practically,  though  not  quite  scientifically — may  be  in- 
herited. At  certain  stages  of  this  long,  chronic  disease,  syphilitic 
parents  transmit  the  germ  to  their  children  before  birth.  The  child 
so  infected  may  have  all  the  complications  of  the  disease,  together 
with  other  special  complaints  peculiar  to  the  second  generation. 

So  much  for  the  dreadful  elder  sister  of  this  pair.  Gonorrhea,  al- 
though much  more  common,  is  far  less  fatal.  It  seldom  if  ever  kills 
directly;  it  may,  however,  lead  its  victim  into  certain  fatal  diseases, 
and  increase  the  mortality  in  others.  But  the  statistics  on  gonorrhea 
are  still  so  uncertain  that  we  would  better  leave  its  fatal  effects  out 
of  consideration.  In  modern  war,  artillery  fire  kills  two  men  where  it 
wounds  three;  in  actions  of  a  certain  kind,  rifle  and  machine-gun  fire 
kills  one  man  where  it  wounds  six  or  seven.  Syphilis  is  the  artillery 
of  our  hidden  foe;  gonorrhea  is  his  small-arms.  And  the  wounds  and 
mutilations  inflicted  by  this  lesser  but  more  prevalent  disease  rival 
the  wounds  and  mutilations  of  war.  Until  recently,  most  of  the  chil- 
dren blind  from  birth  owed  their  pathetic  affliction  to  a  parent  in- 
fected with  gonorrhea.  Modern  research  into  the  causes  of  so-called 
"female  complaints"  has  brought  out  appalling  facts.  Far  the  greater 
and  more  dangerous  part  of  these  diseases  arises  from  gonorrhea,  and 
from  nothing  else.  When  this  kind  of  "female  complaint"  has  gone 
far  enough,  nothing  will  prevent  premature  invalidism  but  a  drastic 
surgical  operation.  The  woman  so  treated  can  never  again  bear  chil- 
dren. This  is  a  pathetic  feature  of  the  case  against  gonorrhea.  Most 
of  these  victims  cannot  be  dismissed  with  the  glib,  shallow  phrase, 
"They  brought  it  on  themselves."  A  large  part  of  the  pelvic  and  ab- 
dominal operations  on  women  are  made  necessary  by  gonorrhea. 
Many  if  not  most  of  the  women  who  submit  to  this  operation,  which 
leaves  them  barren  for  life,  have  never  transgressed  the  accepted  law 
of  sexual  morality — they  are  paying  the  penalty  for  the  promiscuity 
of  their  husbands  before  marriage. 

However,  in  striking  at  the  foundations  of  the  race,  gonorrhea  does 
not  strike  through  the  woman  alone.  In  another  manner,  equally  cer- 
tain, it  produces  sterility  in  males.  Syphilis  cuts  down  the  trunk  of 

[3] 


our  race;  gonorrhea  attacks  it  at  its  origin.  Syphilis  destroys  life  in 
its  full  bloom;  gonorrhea  prevents  life. 

We  Americans,  as  a  people,  think  a  great  deal  of  efficiency.  Prob- 
ably national  efficiency  has  no  enemy  so  powerful  and  persistent  as 
this  lesser  of  the  two  antisocial  diseases.  Except  in  its  more  acute 
early  stages  or  its  long,  late  complications,  it  seldom  puts  its  victim 
to  bed.  If,  like  smallpox  or  typhoid  fever,  it  ran  a  violent  course, 
killed  or  passed  over  in  a  few  weeks,  it  would  trouble  us  less.  The 
victim  goes  about  week  after  week,  month  after  month — in  the  cases 
where  he  is  not  properly  treated,  year  after  year — in  a  state  of  reduced 
vitality.  The  bill  is  large,  owing  to  the  astonishing  prevalence  of  this 
disease.  Though  they  thought  they  knew  the  worst,  our  army  medical 
authorities  were  appalled,  when  they  examined  our  recruits  for  the 
late  war,  by  the  number  of  men  infected  with  gonorrhea.  Many 
authorities  say  flatly  that  it  is  second  if  not  the  most  common  of  all 
diseases.  One  authority  estimates  that  in  reduced  efficiency  it  costs 
us  $300,000,000  a  year.  This  figure,  unlike  those  which  I  have  quoted 
above,  is  only  shrewd  guesswork.  Still,  few  who  understand  the  sub- 
ject would  call  it  exaggerated. 

So  much  for  what  they  are,  these  two  costly  plagues.  There  would 
be  no  use  in  advertising  them,  as  I  am  doing  here,  were  the  case  hope- 
less. It  is  far  from  that.  They  may  be  cured.  They  can,  with  sufficient 
effort,  be  generally  eliminated  from  the  race,  reduced  to  the  status 
of  the  rare  diseases.  That  is  the  tragedy  of  the  situation.  With  the 
weapons  long  forged  and  ready,  we  have  meekly  submitted  year  after 
year  to  our  greatest  racial  enemy. 

How  many  pock-marked  acquaintances  have  you?  Myself,  I  can 
call  to  mind  one.  How  often  do  you  notice  on  the  streets  a  pock- 
marked face?  Looking  back  over  the  past  four  months,  I  recall  but 
two.  If  you  had  lived  a  century  ago,  you  would  have  seen  pock- 
marking  as  commonly  as  you  now  see  baldness.  Again  and  again  in 
the  biographies  of  the  time — as  of  Samuel  Johnson  or  Fanny  Kemble 
— you  encounter  the  simple  phrase,  "he  was  pock-marked."  In  those 
days,  smallpox  was  never  entirely  quiescent.  It  killed  every  year  its 
thousands  in  small  epidemics.  Occasionally  it  burst  out  into  a  great 
epidemic  which  sent  the  rich  scurrying  away  from  the  centres  of 
infection,  and  slew  by  the  tens  of  thousands  those  who  must  remain. 
Now,  smallpox  is  so  rare  that  we  scarcely  take  the  trouble  to  tabulate 

[4] 


it  among  the  causes  of  death.  What  quelled  this  scourge  ?  An  act  of 
Providence?  Not  at  all.  The  race  took  the  matter  into  its  own  hands. 
First,  medical  men  discovered,  if  not  yet  the  germ  of  smallpox,  at 
least  the  conditions  under  which  it  spread.  They  learned  first  that 
contact  with  an  infected  person,  and,  second,  contact  with  the  articles 
he  had  worn  or  used  during  his  illness,  might  cause  the  disease. 
Next,  that  great  pioneer  Jenner  found  in  vaccination  a  sure  method 
of  prevention.  Then  the  race  went  to  work.  The  clothing,  the  bed- 
clothing,  the  dwelling  of  an  infected  person  were  disinfected.  We  set 
up  hospitals,  to  which  smallpox  patients  were  removed,  in  which 
they  were  kept  isolated.  Slowly  at  first,  and  then  with  increasing 
speed,  civilized  humanity,  especially  in  those  places  most  subject  to 
the  disease,  took  to  vaccination.  In  a  generation  after  Jenner  we 
had  controlled  smallpox;  in  a  century  we  have  put  it  behind  us.  But 
mark  this:  the  movement  went  no  faster  and  no  slower  than  public 
education  in  the  causes  and  prevention  of  the  disease.  Not  until  every 
physician  knew  exactly  what  to  do  in  the  face  of  an  epidemic;  not 
until  local  mayors,  aldermen,  supervisors,  and  boards  of  health  knew 
that  to  maintain  hospitals,  to  isolate  acute  cases,  and  to  disinfect  all 
polluted  objects  was  their  solemn  duty;  not  until  the  dullest  person 
knew  that  he  must  instantly  report  every  case,  and  that  he  could 
escape  the  disease  entirely  if  he  got  himself  vaccinated — not  until 
education  and  open  discussion  had  established  all  this  did  we  con- 
quer smallpox. 

A  generation  ago,  the  warm  regions  of  the  American  continent 
trembled  under  the  fear  of  yellow  fever.  Science  went  to  work,  guided 
now  by  a  light  which  Jenner  lacked — the  germ  theory  of  disease. 
Our  medical  investigators  found  that  the  germ  of  yellow  fever  was 
transmitted  from  victim  to  victim  by  the  bite  of  a  certain  mosquito. 
They  studied  the  habits  of  this  insect;  found  how  it  could  be  de- 
stroyed. At  first  in  the  semi-tropic  parts  of  the  United  States,  then 
in  Cuba,  and  later  in  the  more  thickly  settled  parts  of  South  America, 
sanitary  engineers  went  to  work.  Now,  unless  we  grow  shockingly 
careless,  yellow  fever  will  never  again  trouble  a  well-organized  com- 
munity. Yet  here,  too,  the  work  went  no  faster  than  public  educa- 
tion. The  governing  bodies  of  states  and  municipalities,  and  the  public 
which  kept  them  in  power,  had  to  learn  that  the  Stegomyia  mosquito 
was  deadlier  than  a  rattlesnake,  and  that  they  might  better  poison 

[5] 


their  wells  than  leave  water-barrels  and  sewers  uncovered  and  cis- 
terns unscreened. 

The  same  thing  is  happening  to  typhoid  fever,  which  used  to  cause 
more  deaths  in  armies  than  the  casualties  of  battle,  and  which,  during 
the  late  war,  was  thrust  back  into  the  category  of  rare  diseases.  The 
same  thing  is  happening  to  bubonic  plague  and  cholera.  And  always, 
the  plot  of  the  story  is  the  same.  Medical  investigation  finds  the 
germ  or  the  exciting  cause.  With  that  clue,  medicine  goes  on  to 
ascertain  what  conditions  favor  its  spread.  It  works  out  remedies, 
both  curative  and  preventive.  It  starts  a  campaign  of  education  and 
organization.  The  medical  profession  and  we,  the  public,  move  against 
it  as  a  body — and  that  war  is  won.  The  first  battle,  the  discovery  of 
cause  and  cure,  is  usually  the  hardest.  We  should  be  moving  now  as 
an  organized  army  of  health  against  cancer,  did  we  know  its  cause. 
That,  alas,  remains  a  baffling  mystery  of  science. 

The  first  battle  against  venereal  diseases  was  won  long  ago.  We 
know  that  both  syphilis  and  gonorrhea  are  germ  diseases.  Their  deadly 
agents  have  been  seen  and  studied  in  the  field  cf  the  microscope.  It 
was  Schaudinn  who  first  beheld  and  described  those  pale,  minute 
spirals  which  cause  the  syphilis  plague;  it  was  Wassermann  who 
devised  a  blood  test  to  find  the  disease  even  when  it  lies  dormant 
in  the  body.  Long  before  that,  we  knew  all  we  needed  to  know  about 
the  germs  of  gonorrhea.  And  the  cure  followed.  Even  when  we  were 
still  uncertain  whether  or  no  syphilis  was  a  germ  disease,  the  doctors 
understood  that  a  long  treatment  with  mercury,  scientifically  applied, 
would  arrest — possibly  cure.  Then  came  Ehrlich,  some  eight  or  ten 
years  ago,  with  his  famous  discovery  of  "  606,"  or  salvarsan.  "This," 
said  an  enthusiast,  "will  clean  syphilis  out  of  the  human  system  as 
a  reagent  will  clean  the  poison  out  of  a  reservoir."  Salvarsan  did  not 
quite  live  up  to  this  early  reputation.  But  it  did  prove  one  of  the 
most  valuable  healing  agents  known  to  medicine.  Further,  physicians 
discovered  that  a  combined  salvarsan  and  mercury  treatment,  ex- 
pertly and  persistently  applied,  worked  wonders.  In  plain,  everyday 
language,  salvarsan  held  down  the  troublesome  and  dangerous  symp- 
toms while  killing  a  part  of  the  germs,  and  mercury  cleaned  up  the 
rest.  Any  intelligent  physician  will  tell  you  that  no  other  chronic 
disease  may  be  so  easily,  certainly  cured  as  syphilis — only  provided 
that  the  patient  will  stick  to  a  long  treatment  and  start  it  early. 

[«] 


The  story  of  the  gonorrhea  cure  is  not  quite  so  complete  and 
dramatic  as  that  of  the  syphilis  cure.  Syphilis  is  a  blood  disease, 
running  through  the  hidden  courses  of  the  human  system.  Gonor- 
rhea attacks  the  mucous  membranes — lies,  in  a  manner  of  speaking, 
on  the  surfaces  of  the  body-channels.  Several  chemical  compounds 
were  known  to  be  deadly  enemies  of  the  gonorrhea  germ.  Long  ex- 
perience showed  which  of  these  were  most  efficient.  Medicine  dis- 
covered mechanical  means  of  getting  at  those  deposits  of  germs  which 
lie  quiescent  in  the  hidden  folds  of  the  body,  and  which  make  this 
disease  so  treacherous.  It  is  not,  really,  so  easy  of  treatment  as 
syphilis,  especially  when  it  occurs  in  women.  But  still  it  belongs  in 
the  category  of  curable  diseases — provided  the  skilled  physician 
catches  it  in  the  early  stages.  With  both  of  these  plagues,  an  ounce 
of  prompt  treatment  is  worth  a  pound  of  late  treatment.  Syphilis 
practically  never,  and  gonorrhea  seldom,  runs  its  course  and  cures 
itself  as  do  typhoid  fever,  smallpox,  and  most  epidemic  diseases. 
If  neglected,  both  not  only  entrench  themselves  in  the  system,  but 
they  often  lead  to  complications  which  are  virtually  incurable. 

So  the  cause  and  cure  were  known;  the  first  battle  was  won.  Knowl- 
edge of  the  conditions  under  which  these  diseases  spread  was  almost 
as  old  as  the  diseases  themselves;  and  science  bolstered  that  knowledge 
with  hard  facts.  The  open  sewer  which  spreads  venereal  disease  is 
prostitution.  Most  epidemic  diseases  have  some  "carrier."  In  typhoid 
fever  it  is  infected  water  or  milk,  or  the  household  fly.  In  yellow  fever, 
it  is  the  Stegomyia  mosquito.  In  bubonic  plague,  it  is  the  rat — or 
rather  his  parasite,  the  rat-flea.  The  fly,  the  mosquito,  the  rat  of 
venereal  disease  is  the  commercialized  prostitute.  Whenever  we  dipped 
into  the  underworld  in  pursuit  of  knowledge  on  this  subject,  we 
found  astonishing  figures.  Three  hundred  and  twenty  Barbary  Coast 
prostitutes  in  San  Francisco  were  examined  during  their  working 
hours  for  syphilis  alone.  Ninety-seven  per  cent  had  the  disease!  The 
Baltimore  Vice  Commission  found  that  of  320  prostitutes  in  the  red- 
light  district,  96  per  cent  had  either  syphilis  or  gonorrhea  or  both. 
A  similar  investigation  by  the  Detroit  Board  of  Health  showed  94 
per  cent.  Let  us  be  honest  and  admit  that  not  every  man  who  goes  with 
these  women  will  catch  disease.  In  certain  stages,  neither  syphilis  nor 
gonorrhea  can  be  communicated,  as  in  certain  other  stages  they  most 
certainly  can.  Further,  not  every  one  directly  exposed  to  venereal 

[7] 


disease  catches  it;  but  the  same  is  true  of  other  contagious  diseases. 
During  the  typhoid-fever  epidemic  at  Stanford  University  some  fifteen 
years  ago,  four  students  stopped  at  a  dairy  farm;  and  all  had  a  drink 
of  milk  from  the  same  can.  This  milk  was  infected  with  typhoid. 
None  of  the  four  was  technically  immune,  for  none  had  ever  gone 
through  typhoid  fever;  and  this  was  before  the  discovery  of  the 
typhoid  inoculation.  Two  of  the  four  came  down  with  typhoid  fever; 
two  escaped  absolutely.  Smallpox  has  its  stages  when  it  can  be 
communicated  and  when  it  cannot;  and  certain  people  in  certain 
conditions  of  the  system  do  not  "catch"  it,  even  when  exposed.  The 
man  who  goes  with  one  of  these  women  stands  about  the  same  chance 
to  escape  undamaged  that  he  would  stand  if  he  had  spent  an  hour  in 
the  embraces  of  a  smallpox  patient,  had  been  bitten  by  a  Stegomyia 
mosquito,  or  had  drunk  from  a  well  polluted  with  typhoid  germs. 

Step  one:  find  the  cause  and  cure  of  the  disease.  Step  two:  find 
the  conditions  under  which  it  develops.  Step  three:  organize  and  put 
it  out  of  business.  With  the  medical  profession  as  officers,  with  state 
and  national  boards  of  health  as  a  general  staff,  raise  and  train  your 
battalions,  divisions,  and  armies  from  us,  the  people.  This  last  step, 
though  by  far  the  most  laborious,  is  in  the  typical  fight  against  a 
disease  the  easiest  of  all.  To  track  down  a  disease  to  its  ultimate 
cause  and  to  discover  the  remedy  takes  genius;  and  genius  is  very 
rare  and  precious.  To  organize,  when  the  facts  and  the  remedy  are 
known,  takes  only  the  big,  wide-thinking,  common  mind  which  we 
use  every  day  in  big  business  and  big  politics. 

But  this  fight  is  different.  The  difficulty  is  to  raise  the  forces.  Just 
now,  the  army  against  venereal  disease  looks  like  a  general  staff  and 
a  fine  corps  of  trained  officers  without  sergeants,  corporals,  and  pri- 
vates. So  far,  and  in  the  face  of  the  appalling  facts  which  I  have 
quoted  above,  the  eminent  and  devoted  leaders  in  our  struggle 
against  venereal  disease  have  not  succeeded  in  getting  the  country 
"heated  up"  on  the  subject,  as  New  Orleans  got  heated  up  on  yellow 
fever,  as  we  all  got  heated  up  on  influenza.  Why?  Because  as  a  gen- 
eral rule  the  moral,  decent,  and  devoted  part  of  our  communities,  the 
very  people  whom  we  most  need  in  this  endeavor,  take  the  attitude 
of  the  silly  little  girls  in  the  boat.  It  is  a  shameful  thing;  therefore 
it  is  not  to  be  discussed.  The  average  newspaper  which,  until  a  few 
years  ago,  printed  for  money  the  obscene  advertisements  of  quacks, 

[8] 


shrank  from  admitting  to  its  columns  the  words  "syphilis"  and 
"gonorrhea,"  or  even  the  idea  of  venereal  diseases.  And  this  was  not 
so  much  the  fault  of  the  editors  as  of  subscribers,  who  would  stop 
a  newspaper  containing  "such  thoughts." 

Public  ignorance  on  this  topic  is  dense,  black.  Among  intelligent, 
educated,  able  men  of  my  acquaintance,  I  find  common  the  belief 
that  syphilis  and  gonorrhea  are  one  and  the  same  disease,  whereas 
they  bear  no  more  relation  to  each  other  than  scarlet  fever  to  small- 
pox. In  America,  we  cannot  create  enthusiasm  without  discussion; 
and  we  need  enthusiasm  to  arouse  that  gigantic  national  will  by 
which  America  works  her  marvels. 

Yet  the  general  staff  has  ordered  battle  with  what  forces  it  has, 
and  the  organized  fight  has  even  now  begun.  In  the  late  war,  the 
medical  officers  of  every  army  made  a  systematic  struggle  against 
venereal  disease.  They  had  to;  left  alone,  it  might  have  beaten  them 
unassisted  by  the  enemy.  Do  the  best  they  could,  the  British  Royal 
Army  Medical  Corps  reported  that  the  venereal  diseases  kept  con- 
stantly out  of  action  enough  British  soldiers  to  diminish  seriously 
the  fighting  strength  of  the  army.  The  war,  further,  dragged  into 
action  and  put  on  a  common  field  the  great  directing  medical  men 
of  all  the  allied  nations.  On  its  medical  side,  it  was  one  long  world- 
convention  of  great  physicians.  Before  they  separated  and  sailed 
from  France,  they  had  consulted,  thrashed  out  plans  to  put  world- 
wide team-work  into  the  fight  against  diseases,  especially  tubercu- 
losis, gonorrhea,  and  syphilis.  The  great  Red  Cross  Conference  at 
Cannes,  France,  convened  in  April,  19 19.  Every  day  a  considerable 
portion  of  the  time  was  given  to  a  discussion  of  the  venereal  disease 
problem.  Here  a  general  plan  of  strategy  was  laid  out  and  agreed 
on;  our  delegates  returned  home  to  do  their  part. 

I  have  no  room  here  to  describe  the  plan  of  strategy  laid  out  by 
the  Red  Cross  Conference  at  Cannes;  but  I  will  touch  upon  some  of 
the  phases  which  most  concern  us.  First  is  the  curative  campaign. 

Until  a  few  years  ago,  the  average  man  stricken  with  either  syphilis 
or  gonorrhea  was  a  prey  first  to  his  own  ignorance  and  second  to 
the  quacks.  If  these  diseases  stretched  a  man  at  once  on  his  back, 
impotent  with  fever  and  pain,  they  would  doubtless  be  less  trouble- 
some to  society.  But  usually  he  keeps  on  his  feet;  he  can  still  go 
about  his  business.  So  a  certain  proportion  of  the  afflicted  applied 

[9] 


some  patent  remedy,  always  worse  than  useless,  or  neglected  the 
early  stages  altogether.  A  greater  proportion  ran  to  the  quacks.  These 
men,  usually  physicians  without  standing  in  their  profession,  used  to 
fill  the  newspapers  with  display  advertisements  of  "sure-shot"  cures. 
As  a  class,  the  venereal  quacks  were  after  but  one  thing — the  victim's 
money.  Sometimes  they  applied,  though  carelessly  and  inexpertly, 
the  approved  remedies.  Sometimes  they  gave  no  treatment  worth 
the  name,  but  only  hocus-pocus.  And  usually,  when  they  saw  no 
more  money  in  sight,  they  applied  some  temporary  alleviant,  per- 
suaded the  victim  that  he  was  cured,  and  turned  him  loose.  So  general 
and  dense  was  the  ignorance  about  the  "secret  diseases"  and  their 
treatment  that  the  farm-hands  and  cowboys  of  the  West,  for  example, 
believed  that  a  regular  physician  would  not  handle  a  case  of  venereal 
disease — that  the  victim  must  take  to  quacks  or  to  patent  medicines. 

There  was  a  shade  of  truth  in  this  idea.  So  disreputable  had  the 
quacks  made  the  treatment  of  these  diseases,  so  nasty  nice  was  the 
attitude  of  the  public,  that  general  practitioners  disliked  to  take  a 
case  of  venereal  disease.  Even  yet,  they  tend  to  pass  it  on  when  they 
can.  And  the  quack,  though  long  ago  shut  out  from  most  of  the  news- 
papers, is  still  with  us,  slaying  his  thousands.  So  here  is  the  first 
movement  of  the  campaign.  The  United  States  Public  Health  Service, 
which  is  officially  leading  the  campaign,  wants  to  make  it  possible 
and  even  compulsory  for  every  person  afflicted  with  venereal  disease 
to  get  good,  expert  treatment  regardless  of  his  ability  to  pay.  Already, 
many  of  the  larger  cities  have  free  venereal  disease  dispensaries, 
where,  usually,  the  patient  fares  better  than  he  would  at  the  hands 
of  a  general  practitioner,  since  the  staffs  of  these  dispensaries  are 
specialists.  The  medical  profession  wants  to  extend  the  system  until 
every  city  of  more  than  8,000  inhabitants  has  such  an  institution. 
In  these  days  of  rapid  transportation,  they  believe  this  will  cover 
the  rural  as  well  as  the  city  population. 

Of  course,  the  $4,100,000  appropriated  by  Congress,  and  the  funds 
added  from  other  federal  sources,  will  not  begin  to  cover  the  cost  of 
dispensaries.  The  funds  of  the  American  Social  Hygiene  Association 
will  serve  but  to  aid  the  campaign  of  organization  and  education — the 
expenses  of  the  general  staff.  States,  counties,  and  municipalities  must 
do  the  rest.  Already,  the  authorities  of  almost  every  state  have  re- 
sponded— some  weakly,  some  whole-heartedly.  The  weak  ones  will 

[10] 


never  put  heart  into  the  work  until  forced  by  the  public.  There  is  the 
first  job  for  you,  John  Smith,  and  for  you,  the  lately  enfranchised 
Mary  Smith.  The  general  procedure  will  be  in  all  states  the  same. 
An  expert  on  the  treatment  of  venereal  diseases  and  on  the  social 
methods  of  fighting  them  will  be  detailed  to  the  state  board  of  health 
by  the  surgeon-general  of  the  United  States  Public  Health  Service. 
He  will  father  the  work  of  the  dispensaries.  Part  of  his  job  will  be 
holding  the  dispensaries  up  to  the  most  approved  modern  methods. 
From  laboratories  under  governmental  supervision,  he  will  get  in 
their  purity  the  drugs  necessary  to  the  cure.  This  is  important. 
Arsphenamine  ("606"),  for  example,  requires  expert  manufacture. 
It  was  devised  in  Germany,  and  until  the  war  Germany  had  a 
monopoly  of  its  manufacture.  With  the  German  supply  cut  off,  our 
chemists  had  to  learn  the  method.  Now  the  laboratories  of  America 
make  the  best  of  all  remedies;  and  the  product  of  these  laboratories 
is  available  for  the  state  and  municipal  dispensaries. 

A  closely  knit  organization  encompassing  the  efforts  of  all  agencies 
fighting  for  venereal  disease  control  has  been  effected  through  the 
Division  of  Venereal  Diseases  of  the  United  States  Public  Health 
Service,  for  the  purpose  of  meeting  the  problems  in  medical  service, 
education,  law  enforcement,  and  social  service. 

Even  at  this  moment,  the  work  has  gone  far  enough  so  that  a 
victim  of  syphilis  or  gonorrhea  who  is  unable  to  pay  a  private  physi- 
cian may  get  in  touch  with  the  best  modern  treatment  by  writing 
to  his  state  board  of  health.  How  much  this  spread  of  scientific  treat- 
ment will  do  to  reduce  deaths  from  syphilis,  devastating  operations 
on  women,  blindness,  physical  defects,  and  idiocy  in  children,  we 
cannot  even  guess.  Yet  here  is  a  glimpse.  Babies  of  gonorrheal  mothers 
are  likely  to  go  blind.  At  birth,  they  get  the  infection  in  their  eyes. 
Now  the  surfaces  of  the  eye  are  easily  reached  by  drugs,  and  nitrate 
of  silver  is  almost  invariably  fatal  to  the  germ  of  gonorrhea.  One  by 
one,  our  states  passed  laws  requiring  physicians  and  midwives  to 
treat  the  eyes  of  all  babies,  at  birth,  with  nitrate  of  silver.  In  the  past 
generation,  80  per  cent  of  blind  children  were  said  to  owe  their 
affliction  to  this  cause;  in  this  generation,  only  20  per  cent. 

The  universal  free  dispensary  will  do  much  toward  quelling  the 
old  enemy.  And  still,  it  is  only  the  lesser  feature  of  the  campaign. 
In  a  yellow  fever  epidemic  we  establish  hospitals,  staff  them  with 


experts,  send  for  the  best  drugs  and  apparatus,  screen  our  houses 
against  the  fatal  mosquito.  But  that  is  not  enough.  If  we  want  to 
be  free  from  the  disease,  then  and  forever,  we  must  get  at  the  mos- 
quito and  at  the  environment  where  he  breeds.  So,  if  we  are  to  succeed 
in  the  most  important  piece  of  sanitary  work  ever  undertaken  by- 
man,  we  must  drain  the  stagnant  swamps  of  the  underworld  where 
flourishes  that  deadly  mosquito,  the  commercialized  prostitute. 

That  job  is  not  easy;  not  nearly  so  easy  as  draining  the  swamps, 
flushing  the  sewers,  and  screening  the  cisterns  of  a  yellow  fever  dis- 
trict. In  New  Orleans  during  the  trying  days  of  epidemic,  no  sensible 
person  who  understood  the  problem  was  ever  in  two  minds  about 
what  must  be  done.  Especially,  no  one  was  driven  by  any  natural  or 
unnatural  desire  to  have  contact  with  a  Stegomyia  mosquito.  But 
when  we  come  to  attack  commercial  prostitution  we  meet  a  human 
problem.  On  the  respectable  side  of  society  we  must  deal  with  diverse 
views  of  morals  and  law  enforcement,  with  whims,  notions,  fancies, 
and  especially  with  false  modesty.  And  the  prostitute  cannot  be 
wiped  out  with  one  swat,  like  a  mosquito.  She  is  a  human  being — 
sometimes  purely  wicked,  sometimes  only  unfortunate,  sometimes 
intelligently  evil,  sometimes  merely  underbrained — but  a  human  being 
with  a  soul  and  with  certain  inherent  rights.  The  job  is  hard,  but 
when  did  Americans  ever  hesitate  to  tackle  a  hard  job?  Our  gigantic 
will  is  our  main  hold,  and  "It  can  be  done"  our  motto.  I  shall  not 
stop  here  to  dwell  on  methods.  The  American  Social  Hygiene  Asso- 
ciation is  waiting  eagerly  to  explain  that.  If  you  will  write  them, 
addressing  105  West  Fortieth  Street,  New  York,  they  will  give  you 
the  benefit  of  accumulated  human  experience  and  governmental  co- 
operation in  putting  down  commercial  prostitution  and  in  curbing 
the  diseases  which  it  breeds. 

Only,  in  spite  of  our  national  will,  our  courage  in  attacking  the 
desperately  hard  job,  we  shall  never  succeed  with  this  one  if  we 
maintain  the  attitude  of  the  silly  little  girls  in  the  boat.  Chambers 
of  commerce,  central  labor  organizations,  boards  of  education, 
churches,  and  not  least  of  all,  women's  clubs,  must  get  sincerely, 
enthusiastically  into  the  fight.  They  must  educate  the  public  until 
the  dullest  yokel  knows  that  a  case  of  venereal  disease  is  as  dangerous 
to  himself  as  a  case  of  smallpox  and  more  dangerous  to  society  in 
general,  that  it  demands  immediate  report  to  the  proper  authorities, 

[»] 


and  early,  expert  treatment,  and  that  the  best  treatment  is  to  be  had 
for  the  asking.  They  must  force  city  governments,  sometimes  half- 
compromise  with  the  powers  of  evil,  to  drain  the  swamps  and  flush 
the  sewers  of  the  underworld.  Going  further,  they  must  work  to 
replace  the  low  dance-hall,  the  red-light  resort,  with  innocent  and 
healthful  recreation.  But  they  will  not  do  this,  they  cannot,  while 
venereal  disease  is  a  subject  only  for  shameful  mention,  in  blushing 
whispers,  among  intimates.  The  great  ally  to  this  most  dangerous 
enemy  of  the  human  race  is  false  modesty. 

We  tingle  with  pride  over  our  mighty  achievement  in  crowning 
the  Great  War  with  victory.  Because  all  America  was  working  with 
a  common  good  will,  we  created  out  of  raw  material  an  army  of 
4,000,000  men,  equipped  them,  sent  them  overseas  at  the  rate  of 
300,000  a  month;  we  raised  sums  of  money  beyond  imagination;  we 
saved  voluntarily  from  our  own  tables  the  food  which  kept  France, 
Great  Britain,  Italy,  and  Belgium  from  starvation.  Could  we  have 
done  that  if  we  had  barred  all  references  to  Germany  from  polite 
society,  if  we  had  mentioned  the  atrocities  in  Belgium  and  northern 
France  only  in  shamefaced  whispers,  if  our  newspapers  had  refused 
to  print  the  name  of  the  Kaiser?  The  leaders  in  our  fight  against 
venereal  disease  want  to  take  over  for  this  campaign  some  of  the 
organized,  self-sacrificing  enthusiasm  which  won  for  us  the  late  war. 
That  enthusiasm  cannot  live  in  a  democracy  like  ours  without  open, 
high-minded  discussion. 


M 


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